Medical insurance refers to social medical insurance. Social medical insurance is a social security system created by our country and the society according to certain relevant laws and regulations to ensure that employees within the scope of insurance have basic medical service needs when they are sick. Basically, the medical insurance fund consists of pooling funds and personal accounts, and all the most basic medical insurance premiums paid by employees themselves are credited to personal accounts; Basically, the medical insurance premiums paid by the employing company are divided into two categories, some of which are classified into individual accounts and some are used to create overall funds.
A piece of news has caused a lot of people's concern and heated discussion: this boy born in 199s paid more than 5, yuan to treat his 58-year-old father. Later, he found that this drug was on the medical insurance list, and he was prosecuted in the outpatient department of the hospital. Zhang Xiaoshuang's father, 58 years old, was hospitalized in Wuxi People's Hospital for 1 days because he felt sick after lung transplantation. During this time, doctors and nurses issued more than 5, kinds of drugs, and then decided to go to the hospital.
Later, Zhang Xiaoshuang found that all these drugs were covered by medical insurance and could be reimbursed. After several discussions with the outpatient department of the hospital, Zhang Xiaoshuang reported the situation of the outpatient department of the hospital to the relevant health committee. During this period, the doctor stopped using the relevant drugs, and his father's condition slowly deteriorated, and he died ten days later. Later, Zhang Xiaoshuang sued the hospital and pharmacy and stipulated to pay more than 44, yuan for medical expenses.
That's the part of his family that he can pay for. When he bought drugs out of pocket, the two drugs used to reimburse Zhang Xiaoshuang's father Feng Weiling and human albumin according to the prescribed expenses were indeed on the medical insurance list. In that case, why did the hospital stipulate that Zhang Xiaoshuang should buy drugs out of pocket? In fact, drugs that are not on the medical insurance list must be available and reimbursed; For various reasons, medical insurance drugs are likely to still need to pay out of pocket.
can the drugs in the medical insurance list be reimbursed? Don't be naive! Many people think that as long as the drugs are included in the medical insurance, they can be reimbursed. In fact, there are certain preconditions for reimbursement of cooperative medical care.
1. It is easy to understand that the drugs you need for surgery must be included in the medical insurance drug list stipulated by the local medical insurance bureau.
2. A lot of people have misunderstood this point. Drug reimbursement not only needs to meet the needs of drug inclusion in the details, but also needs to limit the scope of application and reimbursement amount of some drugs. Not all diseases can be illustrated by examples. Xiao Li and Xiao Wang are hospitalized at the same time, and their human albumin is less than that, so they all need to use human albumin. However, Xiao Zhao's phenomenon is on the applicable symptoms page, but Xiao Zhao's phenomenon is not on the medical insurance page. In this case,
3. The medicine has been purchased in the outpatient department of the hospital, which is listed in the catalogue of commercial insurance documents, but it is not purchased in the outpatient department of the hospital, so it cannot be reimbursed. Then why doesn't the outpatient department of the hospital buy the medicine in the medical insurance? There are many reasons behind it, the proportion of drugs and the pressure of social security in hospital outpatient service are the main factors.
why is there no drug hospital outpatient service in the medical insurance list? Let's take cancer drugs as an example, and you can master the problems of hospitals and hospitals in China! Through difficult negotiations, 17 kinds of cancer drugs entered the medical insurance document catalogue, and then a strange phenomenon appeared. Before entering the medical insurance document catalogue, doctors could buy this drug at their own expense. After entering the list, this drug somehow went to the hospital to "fade".
To put it more simply, the cost, types and quantities of drugs received by hospital outpatient departments are limited every year. If cancer drugs account for most of the cost and quantity, the drugs that can treat common diseases will be reduced. How do you choose to save a person and a group of people? Although the prevalence of cancer is very high in China, compared with other serious diseases, the proportion of cancer is still small. If most of the medical insurance funds are used to treat cancer, the funds for some diseases will be reduced, because there are only so many assets in the medical insurance fund.
It is suitable for patients to restore nutrition and the living expenses of a family, and to make up for the family's income loss caused by backbone disease. Therefore, the most important thing is to know that social security is the welfare guarantee of people's livelihood and cannot resist all kinds of life risks. With the rapid development of the whole society and the soaring medical expenses, commercial insurance is necessary to ensure the health and financial security of the whole family.